体感诱发电位联合血清学指标对AIS患者上肢运动功能恢复的预测价值  

Prediction value of somatosensory evoked potential combined with serological indexes for upper limb functioning in patients with AIS

作　　者：仝霖 万万 罗辉 孙贇 Tong Lin;Wan Wan;Luo Hui;Sun Yun(Shanghai Putuo Liqun Hospital,Shanghai 200000,China)

机构地区：[1]上海市普陀区利群医院急诊科,上海200000

出　　处：《脑与神经疾病杂志》2025年第2期98-103,共6页Journal of Brain and Nervous Diseases

基　　金：上海市普陀区卫生健康系统科技创新项目(ptkwws202215)。

摘　　要：目的探讨体感诱发电位(SEP)联合血清学指标对急性缺血性脑卒中(AIS)患者上肢运动功能恢复的预测价值。方法选取2021年7月至2022年2月在上海市普陀区利群医院接受药物干预和标准化康复治疗的AIS患者作为研究对象,所有患者在急性期接受常规内科药物及肢体康复治疗。测定急性期的SEP和血清指标,于患者发病后48h、3w、12w采用Fugl-Meyer评定法(FMA)和改良Rankin评分(mRS)评定患者上肢功能和神经功能恢复情况。利用受试者工作特征(ROC)曲线分别分析SEP、S-100β及两者联合时的曲线下面积(AUC),确定预测指标最佳截断值、敏感性和特异性。结果本研究最终纳入144例。患者48h、3w和12w的FMA和mRS评分具有中等以上的负相关关系(相关系数均≥0.585,P<0.001)。患者48 h内的FMA评分与3 w和12 w时的FMA评分均强相关(P<0.001);患者48h内的mRS评分与3 w和12w时mRS评分均显著相关(P<0.001)。多因素Logistic回归分析显示,年龄、N20潜伏期和S-100β是影响患者上肢功能恢复情况的独立危险因素(P<0.05)。ROC曲线结果显示,N20潜伏期对患者上肢功能恢复情况预测的最佳截断值为22.03ms;S-100β的最佳截断值为151.82ng·L^(-1)。当两者联合时,对患者上肢功能恢复情况预测的敏感性为73.57%,特异性为91.16%,AUC为0.917;其中AUC大于N20潜伏期和S-100β单一预测(Z=5.427和5.516,P<0.001)。结论AIS患者的FMA评分和mRS评分具有相关性,急性期的N20潜伏期和S-100β是影响患者上肢功能恢复情况的独立危险因素,对患者的上肢功能恢复情况具有预测价值。当两者联合时,预测价值更高。Objective To investigate the prediction value of somatosensory evoked potential(SEP)combined with serological indexes for upper limb functioning in patients with acute ischemic stroke(AIS).Methods Patients with AIS who received drug intervention and standardized rehabilitation treatment in Liqun Hospital,Putuo District,Shanghai from July 2021 to February 2022 were selected as the study subjects.All patients received conventional medical drugs and limb rehabilitation treatment during the acute phase.SEP and serum indexes were measured at the acute stage.The recovery of upper limb function and nerve function was assessed by Fugl-Meyer evaluation(FMA)and modified Rankin score(mRS)at 48 h,3 w,and 12 w after onset.The receiver operating characteristic(ROC)curve was used to analyze SEP,S-100β,and the area under the curve(AUC)of their combination to determine the optimal diagnostic point,sensitivity,and specificity of the predictor.Results A total of 144 patients were eventually included in the study.The FMA and mRS Scores of patients at 48 h,3 w,and 12 w had more than medium negative correlation(correlation coefficients≥0.585,P<0.001).FMA scores within 48 were strongly correlated with FMA scores at 3 w and 12 w(P<0.001).mRS Scores at 48h were correlated with those at 3 w and 12 w(P<0.001).Multi-factor Logistics regression analysis showed that age,N20 latency,and S100βwere independent risk factors affecting the recovery of upper limb function(P<0.05).ROC curve results showed that the best cut-off value of N20 latency for predicting the recovery of upper limb function was 22.03ms.The optimal truncation value of S100βwas 151.82ng·L^(-1).When combined,the sensitivity,specificity,and AUC of upper limb function recovery were 73.57%,91.16%,and 0.917.The AUC was greater than the N20 latency and S100βsingle prediction(Z=5.427 and 5.516,P<0.001).Conclusion There was a correlation between FMA scores and mRS scores in AIS patients.N20 latency and S100βin the acute phase were independent risk factors affecting the recovery

关 键 词：急性缺血性脑卒中 体感诱发电位 S-100Β Fugl-Meyer评定法 改良Rankin评分 

分 类 号：R374.34[医药卫生—病原生物学]